Dive Brief:
- A new report by the Office of the Inspector General (OIG) has revealed deficiencies in internal controls for determining eligibility for the federal healthcare exchange.
- The report found that last year, some consumers who received coverage or subsidies through Healthcare.gov may not have been eligible.
- There were also problems with resolving inconsistencies between information on applications and deferral data.
Dive Insight:
The Centers for Medicare and Medicaid Services (CMS) said the report only examined data from the first open enrollment period, during which time there were a lot of technical glitches with the site. According to CMS, those problems were corrected early on.
The report doesn't go so far as to say that the exchange improperly enrolled applicants or miscalculated subsidies. But it does say that without proper verification of eligibility and resolution of inconsistencies, there's no way to be sure that applicants actually met the eligibility requirements or were given subsidies in the correct amounts.
In its report, the OIG made some recommendations for improving the vetting process. CMS agreed with the recommendations and says it has already taken some steps toward improvement.